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I remember Gillies McKenna imploring interviewees to "change the world" through research. Sad how the promise of radiation oncology research to improve outcomes has gradually spiraled into disillusionment over the years first through non-inferiority, detouring into wasteful and non-superior protons and now into straight political ideology.
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I'm going to come out of left field with unexpected optimism:

This is all speculation on my part, as a disclaimer. However, I think we're witnessing a Thomas Kuhn-style paradigm shift in RadOnc, and this research is the inevitable result of the cycle we've been in for the last 20 years.

What in the world am I talking about?

As I'm quite fond of pointing out, the Boomers have a deathgrip on RadOnc. These people finished residency from the late 1980s through the early 2000s. In their defense, the RadOnc technology of their time was totally different compared to what we have now.

As we all know, they doubled residency size and due to various factors, RadOnc was one of the most competitive specialties from about 2003/2004 - 2018/2019.

If you factor in the 5-year training lag, and the fact that people in power just don't give up power like, ever, there is an absolute army of some of the most brilliant people in American medicine just...stuck. That's a gross oversimplification of course, but a lot of institutional authority is locked up with people who have sat in those positions since George W Bush was president.

Since RadOnc is small, the cultural pressure is more intense - and cultural pressure in medicine is already intense at baseline. That means research in classic establishment institutions has to stick within narrow lanes considered "ok to study".

Those are:

1) Dose escalation (past peak popularity)
2) Omission (sustained popularity)
3) Hypofrac (peak popularity)

There's limited choices outside those three lanes. But you get things like:

1) Machine learning/AI (not a lot of people have the background to engage in that in RadOnc)
2) NCDB/SEER/other databases (very popular because low cost/barrier to entry, low impact)
3) Safety/QI
4) Environmental
5) Culture/DEI

The DEI space appears to be a path for the people who are in the DEI category themselves, and thus has limited generalizability.

If anyone thinks I'm crazy, go read the titles of the abstracts from this year's ASTRO conference, and the last few years. The "big" clinical trials are mostly hypofrac and omission. The residents are mostly engaged in database, QI, or environmental studies. The DEI group does DEI. There's an intense interest in AI but the pipeline to RadOnc is not historically the computer science crowd, so not a lot of people can get into that easily.

Simultaneously: the vast majority have soured on hypofrac and database work. Despite my jokes, there is a role for environmental studies - but for our specialty, for it to be the thing winning research awards and press releases...we've jumped the shark.

It's why we're seeing the interest in benign applications. Not just the low-dose stuff, but also cardiac ablation, SRS for various neurological disorders, etc.

The beginnings of the "crisis" in the paradigm shift is literally written in the literature. Look at the people who published the COVID lung trial. Then, look at the people who authored the "this is bad" anti-COVID lung paper. That's the divide.

Further, everyone keeps talking about FLASH. From a radbio perspective, if you think FLASH (and GRID/LATTICE) are "real" or at the very least plausible, existing theories about radiation biology are insufficient to explain those results. It will require adoption of other theories and models which are currently not showing up on the ABR exams.

So we're at a crossroads. Radiation will remain important in certain cancer applications, as long as cancer exists, and the field can't totally die while that remains true. The "powers that be" will have to leave somehow, either through retirement or their own death, and the army of early career people will be able to fill the vacuum.

None of this is going to be fun. But the 2030s and beyond is probably going to look very different than 2023.

Med students should still look elsewhere, though.
 
elementaryschooleconomics said:
I'm going to come out of left field with unexpected optimism:

This is all speculation on my part, as a disclaimer. However, I think we're witnessing a Thomas Kuhn-style paradigm shift in RadOnc, and this research is the inevitable result of the cycle we've been in for the last 20 years.

What in the world am I talking about?

As I'm quite fond of pointing out, the Boomers have a deathgrip on RadOnc. These people finished residency from the late 1980s through the early 2000s. In their defense, the RadOnc technology of their time was totally different compared to what we have now.

As we all know, they doubled residency size and due to various factors, RadOnc was one of the most competitive specialties from about 2003/2004 - 2018/2019.

If you factor in the 5-year training lag, and the fact that people in power just don't give up power like, ever, there is an absolute army of some of the most brilliant people in American medicine just...stuck. That's a gross oversimplification of course, but a lot of institutional authority is locked up with people who have sat in those positions since George W Bush was president.

Since RadOnc is small, the cultural pressure is more intense - and cultural pressure in medicine is already intense at baseline. That means research in classic establishment institutions has to stick within narrow lanes considered "ok to study".

Those are:

1) Dose escalation (past peak popularity)
2) Omission (sustained popularity)
3) Hypofrac (peak popularity)

There's limited choices outside those three lanes. But you get things like:

1) Machine learning/AI (not a lot of people have the background to engage in that in RadOnc)
2) NCDB/SEER/other databases (very popular because low cost/barrier to entry, low impact)
3) Safety/QI
4) Environmental
5) Culture/DEI

The DEI space appears to be a path for the people who are in the DEI category themselves, and thus has limited generalizability.

If anyone thinks I'm crazy, go read the titles of the abstracts from this year's ASTRO conference, and the last few years. The "big" clinical trials are mostly hypofrac and omission. The residents are mostly engaged in database, QI, or environmental studies. The DEI group does DEI. There's an intense interest in AI but the pipeline to RadOnc is not historically the computer science crowd, so not a lot of people can get into that easily.

Simultaneously: the vast majority have soured on hypofrac and database work. Despite my jokes, there is a role for environmental studies - but for our specialty, for it to be the thing winning research awards and press releases...we've jumped the shark.

It's why we're seeing the interest in benign applications. Not just the low-dose stuff, but also cardiac ablation, SRS for various neurological disorders, etc.

The beginnings of the "crisis" in the paradigm shift is literally written in the literature. Look at the people who published the COVID lung trial. Then, look at the people who authored the "this is bad" anti-COVID lung paper. That's the divide.

Further, everyone keeps talking about FLASH. From a radbio perspective, if you think FLASH (and GRID/LATTICE) are "real" or at the very least plausible, existing theories about radiation biology are insufficient to explain those results. It will require adoption of other theories and models which are currently not showing up on the ABR exams.

So we're at a crossroads. Radiation will remain important in certain cancer applications, as long as cancer exists, and the field can't totally die while that remains true. The "powers that be" will have to leave somehow, either through retirement or their own death, and the army of early career people will be able to fill the vacuum.

None of this is going to be fun. But the 2030s and beyond is probably going to look very different than 2023.

Med students should still look elsewhere, though.
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I think a lot of “leadership” will remain set well into the late 2030s. Many will stay put, treating a handful of pts, spending their days in meetings, and taking home big salaries.
 
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elementaryschooleconomics said:
Thomas Kuhn-style paradigm shift
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If this happens, it will have to come with a radical re-definition of what radiation oncology means. No impending paradigm shift within oncology is going to make our work more significant.

The big historical paradigm shift in therapeutic oncology, as I see it, has been the shift in emphasis from local (or physical) management to systemic (or molecular) management of cancer, with incorporation of all three modalities in the multidisciplinary setting for locally advanced or perhaps oligometastic disease.

However, surgery and radiation are contextualized much, much more by systemic therapy than the other way around....and, systemic therapy is changing and becoming targeted in ways that the other two modalities never will be.

If you imagine 100 years out (impossible really), it gives you the boundary scenario. We are already seeing the seeds of this time now. Just ask yourself, "what the holy grail really is for each modality".

Surgery:

The least invasive and morbid surgeries possible, remarkably standardized through robotics and AI. (as an aside, one might want to look at trends in the number of CABGs per year in a population where the oldest boomer is 77).

Radiation Oncology:

The least invasive, time consuming and morbid radiation possible. Maximizing stereotaxy and minimizing time, remarkably standardized through robotics and AI.

Medical Oncology:

Effective and generalizable liquid biopsies for incipient (but clinically meaningful) cancers....

A full understanding of what constitutes clinically meaningful cancer. (forget treating DCIS in many, many patients)

Biohacking to prevent malignancy with redundant tumor suppressor genes (or other) through CRISPR like technology in at risk patients (or perhaps embryonically for the well to do).

Supereffective targeted therapy for malignancies that emerge despite the above initiatives.

No amount of latent brain power is going to make radiation oncology the place to be, if the focus remains strictly the administration of radiation to cancer. Even today, our best researchers often pretend to do radiation research while really doing generalizable molecular oncology work.

Hopefully, a generation young enough to be staring 30 years of work in the face will take on the challenge of redefining the field entirely. Lots of places to go....all with painful journeys to get there.
 
Pro Wrestling Sport GIF by ALL ELITE WRESTLING


I guess I'm glad to have enjoyed the golden era of radiation oncology. I'll see myself out thru the d##r..
 
communitydoc13 said:
If this happens, it will have to come with a radical re-definition of what radiation oncology means. No impending paradigm shift within oncology is going to make our work more significant.

The big historical paradigm shift in therapeutic oncology, as I see it, has been the shift in emphasis from local (or physical) management to systemic (or molecular) management of cancer, with incorporation of all three modalities in the multidisciplinary setting for locally advanced or perhaps oligometastic disease.

However, surgery and radiation are contextualized much, much more by systemic therapy than the other way around....and, systemic therapy is changing and becoming targeted in ways that the other two modalities never will be.

If you imagine 100 years out (impossible really), it gives you the boundary scenario. We are already seeing the seeds of this time now. Just ask yourself, "what the holy grail really is for each modality".

Surgery:

The least invasive and morbid surgeries possible, remarkably standardized through robotics and AI. (as an aside, one might want to look at trends in the number of CABGs per year in a population where the oldest boomer is 77).

Radiation Oncology:

The least invasive, time consuming and morbid radiation possible. Maximizing stereotaxy and minimizing time, remarkably standardized through robotics and AI.

Medical Oncology:

Effective and generalizable liquid biopsies for incipient (but clinically meaningful) cancers....

A full understanding of what constitutes clinically meaningful cancer. (forget treating DCIS in many, many patients)

Biohacking to prevent malignancy with redundant tumor suppressor genes (or other) through CRISPR like technology in at risk patients (or perhaps embryonically for the well to do).

Supereffective targeted therapy for malignancies that emerge despite the above initiatives.

No amount of latent brain power is going to make radiation oncology the place to be, if the focus remains strictly the administration of radiation to cancer. Even today, our best researchers often pretend to do radiation research while really doing generalizable molecular oncology work.

Hopefully, a generation young enough to be staring 30 years of work in the face will take on the challenge of redefining the field entirely. Lots of places to go....all with painful journeys to get there.
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In your Med Onc scenario, can also boil down to robots and AI.

Go to future Walmart, give blood sample, step into next stall where you get an injection of whatever concoction you need.

I don't think it makes sense to consider these things to the absurd extreme where we are all obsolete.

I think we've talked as nauseum about ways we can transform the field in this forum, including opportunities like giving systemic therapy or creating an IR-like arm of the field. All these have obstacles and opportunities, but I agree with the central thesis that the field as it is now will need to change to stay relevant.
 
CaesarRO said:
In your Med Onc scenario, can also boil down to robots and AI.

Go to future Walmart, give blood sample, step into next stall where you get an injection of whatever concoction you need.

I don't think it makes sense to consider these things to the absurd extreme where we are all obsolete.

I think we've talked as nauseum about ways we can transform the field in this forum, including opportunities like giving systemic therapy or creating an IR-like arm of the field. All these have obstacles and opportunities, but I agree with the central thesis that the field as it is now will need to change to stay relevant.
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Radonc will not be obselete in the foreseeable future, but many radoncs could be.
 
CaesarRO said:
I don't think it makes sense to consider these things to the absurd extreme where we are all obsolete.
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RickyScott said:
Radonc will not be obselete in the foreseeable future, but many radoncs could be.
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Agree entirely with both statements.

The trajectory just should be taken seriously...in terms of size of the field, ,considered scope of the field and the prospective radonc's interest.

I do disagree strongly with the thesis that a bunch of very smart but constrained people will inevitably do great things...very smart people need support and space to operate to do great things.
 
communitydoc13 said:
Agree entirely with both statements.

The trajectory just should be taken seriously...in terms of size of the field, ,considered scope of the field and the prospective radonc's interest.

I do disagree strongly with the thesis that a bunch of very smart but constrained people will inevitably do great things...very smart people need support and space to operate to do great things.
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To refine my theory a bit (obviously not speaking for anyone else):

I'm playing the odds. I believe that every human group is a bell curve and is fiercely tribal. There's an "in-group" and an "out-group". There's geniuses and...not geniuses.

All it will take is 3-5 Radiation Oncologists getting into positions where they can leverage institutional authority and start pushing "new" directions (or resurrecting old ones). The pent up energy will then flow in those directions accordingly.

We're seeing it now with LDRT as osteoarthritis. The Red Journal review article was the #4 most downloaded article of 2022. I personally know more and more people deploying it in their own practices today than even 6 months ago. I know at least one "brand name" organization with an institutional protocol used across their network. I know at least one non-RadOnc practice dedicated to this exclusively.

Cardiac SBRT is another. The fact that ASTRO isn't trumpeting that from all rooftops everywhere boggles my mind (but is completely in character for them). That's a little more intensive than LDRT, but you could look at oligomets as a possible timeline...though hopefully we're a little fast than 30 years, haha.

It's statistically improbable that there aren't 3-5 "thought leaders" who graduated residency in the last decade or so willing and able to take us out of stagnation.

Of course - I could be wrong.
 
The people at the big centers don’t face the same issues we do.

What do I want?

I want an endless stream of patients with curable and incurable cancer and a variety of benign patients. I want to provide high quality multi-disciplinary care and every thing I do off-protocol will be as the U, while our customer service and speed will be better.

This is not in alignment with the academic centers. They are seeing 10-14 head and necks on one day with a resident and students in tow. They are doing 12k RVUs while claiming to be a academically productive. They are doing all the can to have patients get less or no radiation.

The thought leaders, if based at academic centers, are directly repellant to what I need them to do. This is why (and I know unpopular opinion) I think guys like Steinberg should be chair at academic centers. Give me a Stu Burri as chair of Duke, give me a Bob Cardinale as chair of Sloan, give me a Bill Hartsell as chair of U of Chicago. It doesn’t matter if you can run a lab as a chair. You need to find people to run exciting and innovating labs for your departments and nurture them. You need grinders to do 12k rvu without pretending they are the same as your 50/50 research gal and pay them accordingly.

The template of what we consider leadership must change.
 
RealSimulD said:
It doesn’t matter if you can run a lab as a chair. You need to find people to run exciting and innovating labs for your departments and nurture them. You need grinders to do 12k rvu without pretending they are the same as your 50/50 research gal and pay them accordingly.
Click to expand...

I think it does matter if you can run a lab as chair.

In my opinion, if you can't run a lab yourself, you have no idea what it's like to run a lab, and you can't create the environment necessary for a physician-scientist to succeed.

There are certainly a growing number of academic departments being led by politically astute clinical faculty for the benefit of clinical metrics.

If that's what we want--all the clinical work and revenue to flow into the academic departments while we become more of a service or an order like radiology--this is the path forward.
 
Neuronix said:
I think it does matter if you can run a lab as chair.

In my opinion, if you can't run a lab yourself, you have no idea what it's like to run a lab, and you can't create the environment necessary for a physician-scientist to succeed.

There are certainly a growing number of academic departments being led by politically astute clinical faculty for the benefit of clinical metrics.

If that's what we want--all the clinical work and revenue to flow into the academic departments while we become more of a service or an order like radiology--this is the path forward.
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It is mind boggling how so many chairs don’t understand what it takes to run a lab or get research funding.
 
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It seems to me that the real problem arose when academic medical centers had the power taken over by business interests over academic interests. That's exactly how we got so much competition, building, and growth growth growth in those arenas, taking away from the freestanding PP or independent hospital world of cancer care.
 
Neuronix said:
If that's what we want--all the clinical work and revenue to flow into the academic departments while we become more of a service or an order like radiology--this is the path forward.
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I couldn't agree more.

In fact, many of our problems, including oversupply and consolidation, stem from corporatist approaches to academic radonc. Your MD/PhD star resident? Offer them a satellite job with tons of barriers to academic productivity.

Academics should be small. They should trust their non-academic alumni to run community radiation oncology. Everybody would feel better.
 
communitydoc13 said:
I couldn't agree more.

In fact, many of our problems, including oversupply and consolidation, stem from corporatist approaches to academic radonc. Your MD/PhD star resident? Offer them a satellite job with tons of barriers to academic productivity.

Academics should be small. They should trust their non-academic alumni to run community radiation oncology. Everybody would feel better.
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Too look at the proximate cause of these horrible trends - how much was caused by poorly conceived government regulations? Creation of PPS exempt cancer hospitals and Obamacare with "meaningful" use have horribly exacerbated these trends.
 
theradiator said:
Too look at the proximate cause of these horrible trends - how much was caused by poorly conceived government regulations? Creation of PPS exempt cancer hospitals and Obamacare with "meaningful" use have horribly exacerbated these trends.
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I am sure it was a component, but uniquely terrible leadership/self interest is the primary root cause. Remember, we expanded more than every other speciality- why are we such a total outlier/aberration?
 
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drowsy12 said:
It seems to me that the real problem arose when academic medical centers had the power taken over by business interests over academic interests. That's exactly how we got so much competition, building, and growth growth growth in those arenas, taking away from the freestanding PP or independent hospital world of cancer care.
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Yes. I always viewed academics as nose down, trying to solve problems/run trials, do the bench research.

Somewhere over time "expanding the footprint" of the department (NOT of the field, of the dept) and growing the dept became a bigger priority and has had MASSIVE implications. Which led to the phenomenon of the dept "needing" more residents, without taking one second to consider if the field or the patients as a whole needed more radiation oncologists.
 
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BobbyHeenan said:
Somewhere over time "expanding the footprint" of the department (NOT of the field, of the dept) and growing the dept became a bigger priority and has had MASSIVE implications. Which led to the phenomenon of the dept "needing" more residents, without taking one second to consider if the field or the patients as a whole needed more radiation oncologists.
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Astro's official position for years was it would run afoul of "anti trust" laws for even thinking about such things. Justice Department would be all over them. Of course it was just a nonsensical excuse/smoke screen but hey.
 
communitydoc13 said:
Academics should be small. They should trust their non-academic alumni to run community radiation oncology. Everybody would feel better.
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I do wonder if this is why there seems to be more in field animosity than with surgical onc specialties or med onc…

There is that old adage that 80% of cancer care is delivered in the community. As >50% of new grads are taking university employed jobs, have to wonder if this is true for radiation care.
 
NotMattSpraker said:
I do wonder if this is why there seems to be more in field animosity than with surgical onc specialties or med onc…
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I think it's obvious.

Academics should be a privilege. More prestige and the opportunity to do really creative stuff. In my training program, it was a good thing to be encouraged to go into academics (I was not).

In the mid 2000s (before I was in training) good academic places were losing talented young faculty to excellent PP opportunities. (We all know the timeline of increased IMRT utilization). There was even a time where a first job at your home institution could be a bit of a place holder for some young graduates who were lining up good community opportunities in their location of choice.

As far as I can tell, none of these folks were getting paid fellowship salaries.

This isn't a bad thing. It's a good thing. The most important part of being good at a given job is being committed to the mission. It's appropriate for many young academic docs to move on after a few years, once they realize that the particular grind is not for them.

The subsequent ten or so years (massive expansion of residency programs and large academic centers into the community with a willing and highly competitive med student base) changed all that, with a hunger games job search environment, lots of marginal academic jobs and intentional devaluing of community radiation oncology.

It happened fast.
 
communitydoc13 said:
In the mid 2000s (before I was in training) good academic places were losing talented young faculty to excellent PP opportunities. (We all know the timeline of increased IMRT utilization). There was even a time where a first job at your home institution could be a bit of a place holder for some young graduates who were lining up good community opportunities in their location of choice.

As far as I can tell, none of these folks were getting paid fellowship salaries.

This isn't a bad thing. It's a good thing. The most important part of being good at a given job is being committed to the mission. It's appropriate for many young academic docs to move on after a few years, once they realize that the particular grind is not for them.
Click to expand...

I always wonder why our leaders were so short-sighted in realizing that losing people to private practice was actually a good thing, and a sign that the specialty was healthy.
 
Doctorer said:
I always wonder why our leaders were so short-sighted in realizing that losing people to private practice was actually a good thing, and a sign that the specialty was healthy.
Click to expand...
It's just another symptom of their generalized myopia.

For example, our entire economic system is predicated on growth. Each year, without fail, target metrics for all of our budgets will be higher than the previous year. Perhaps not for EVERY metric for all of us, and perhaps not drastically, but we never go backwards.

For many years, leadership forced the growth of the number of Radiation Oncologists through expansion of training programs.

...while simultaneously dedicating the majority of our clinical research efforts towards hypofrac and omission.

They...no one...it wasn't...like...

OF COURSE this would eventually become a problem.

It's breathtaking in its idiocy.
 
elementaryschooleconomics said:
It's breathtaking in its idiocy.
Click to expand...
I think an audit of the chairmen of departments of top 20 residency programs circa 2010 is warranted.

What happened to their careers?

I have not done this audit, but the chairs from this era that I know have done exceptionally well.

Maybe not idiocy...…but certainly not service to the field.
 
communitydoc13 said:
I think an audit of the chairmen of departments of top 20 residency programs circa 2010 is warranted.

What happened to their careers?

I have not done this audit, but the chairs from this era that I know have done exceptionally well.

Maybe not idiocy...…but certainly not service to the field.
Click to expand...

But to the eyes of their bosses (med school deans/admins) they've done a bang up job, so I would expect them to be paid better than ever
- expanded the footprint of the cancer center/radiation dept
- "educated more residents than ever before" - expanding the alumni base
- grew revenue.


The issue is no one was ever looking out for the field as a whole.
 
elementaryschooleconomics said:
It's just another symptom of their generalized myopia.

For example, our entire economic system is predicated on growth. Each year, without fail, target metrics for all of our budgets will be higher than the previous year. Perhaps not for EVERY metric for all of us, and perhaps not drastically, but we never go backwards.

For many years, leadership forced the growth of the number of Radiation Oncologists through expansion of training programs.

...while simultaneously dedicating the majority of our clinical research efforts towards hypofrac and omission.

They...no one...it wasn't...like...

OF COURSE this would eventually become a problem.

It's breathtaking in its idiocy.
Click to expand...

These are all features and not bugs for each individual department and each individual Rad Onc chair. Nobody was caring about the field as a whole. Everyone wanted to get theirs.
 
BobbyHeenan said:
But to the eyes of their bosses (med school deans/admins) they've done a bang up job, so I would expect them to be paid better than ever
- expanded the footprint of the cancer center/radiation dept
- "educated more residents than ever before" - expanding the alumni base
- grew revenue.


The issue is no one was ever looking out for the field as a whole.
Click to expand...
Prisoners dilemma
 
RickyScott said:
But why was radonc more greedy than everyone else?
Click to expand...

Smaller, more nimble field. Easier to buy up other practices. Radiation isn't "elective" so you have geographic capture instantly if you buy up another locoregional practice (unlike say ortho where people can travel to consider where to do their surgery, etc). The pro forma math is easy to understand - this place (community center) treats X patients and their insurance contracts pay $x/fraction.....our $/fraction is way higher.

I'm just spit balling here.
 
BobbyHeenan said:
Smaller, more nimble field. Easier to buy up other practices. Radiation isn't "elective" so you have geographic capture instantly if you buy up another locoregional practice (unlike say ortho where people can travel to consider where to do their surgery, etc). The pro forma math is easy to understand - this place (community center) treats X patients and their insurance contracts pay $x/fraction.....our $/fraction is way higher.

I'm just spit balling here.
Click to expand...

it's pretty straight forward, I agree

1) Hospital CEOs would be dumb not to buy up more linacs during a time when hospital reimbursement is higher. We see/saw this happen over the last 15 years with all kinds of hospitals. whether they are connected to an academic medical center or not, the math is the math, and you would have to be a bad CEO to not grow grow grow. Hospital tells departments - hey this place 90 minutes away? it's now your responsolibty.

2) During these glory days, as departments grew, it made sense to expand, on an individual level, to keep up with the joneses.

hence here we are. tragedy of the commons, etc etc etc.

to me it is pretty simple, and one not need bend things around to fit any conspiracy theories when the truth is pretty simple.

we are now seeing these simple realities in other markets. For example - it is quite dumb that some corporation is not currently capturing all of the Austin market. Hence, MDACC arriving. they are late. they have left money on the table.
 
Does Dr. Adelson really believe this? Does she really believe private practices don't have compounding pharmacists, interventional radiologists, social workers, and a call schedule? Does she believe MDACC takes care of more indigent patients?

Everyone becomes the hero of their own story, and it must feel better to justify the absurd prices obtained via regulatory capture rather than face the truth of the situation.
 

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OTN said:
Does Dr. Adelson really believe this? Does she really believe private practices don't have compounding pharmacists, interventional radiologists, social workers, and a call schedule? Does she believe MDACC takes care of more indigent patients?

Everyone becomes the hero of their own story, and it must feel better to justify the absurd prices obtained via regulatory capture rather than face the truth of the situation.
Click to expand...

Do you have a link to the full article?
 
NotMattSpraker said:
Do you have a link to the full article?
Click to expand...

It was one of those Medscape articles that recaps news- talked about a hearing recently where MDACC docs are working hard to keep the grift going. I hadn't even noticed how she threw community oncologists under the bus, but I am not surprised at all.

For example, I had a surgeon at MDACC Houston tell a patient I would not be able to provide standard-of-care treatment for low rectal cancer, and Dr. Benjamin Smith told a patient of mine with breast cancer I would not be able to spare her heart.

These docs are a real piece of work.
 
elementaryschooleconomics said:
The forums were displaying @OTN's post as an attachment, so just to embed it with highlighting:

View attachment 376894

Stay classy, Anderson.
Click to expand...

Hype. As a hospital based physician, this has me so excited to go out tomorrow and advocate for freestanding practices. Correct the world a little bit.

Why do this as an employed physician? Why say something so unhinged?

[Google searches this doctor]

Oh, lol, yea, shocked to see she is also a breast oncologist.

Hahaha, Chief Value Officer at a PPS-exempt cancer center. That's something.

1695142067213.png
 
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